THE BENEFITS OF NEUROPSYCHOLOGICAL ASSESSMENT IN THE DIAGNOSIS

THE BENEFITS OF NEUROPSYCHOLOGICAL ASSESSMENT IN THE DIAGNOSIS

THE BENEFITS OF NEUROPSYCHOLOGICAL ASSESSMENT IN THE DIAGNOSIS AND TREATMENT OF BRAIN INJURY ADAM BRICKLER, PSY.D. MARCH 1, 2019

GOALS Define neuropsychological assessment Identify advantages of neuropsych testing vs. neuroimaging Discuss value of neuropsych assessment in differentiating and/or establishing severity of

injury Review various neuropsychological evaluation processes DEFINITION OF NEUROPSYCHOLOGICAL ASSESSMENT A branch of clinical psychology that studies how the brain and nervous system

affect how we function on a daily basis Uses various assessment methods to ascertain function and dysfunction and applies this knowledge to evaluate, treat and rehabilitate individuals with suspected or demonstrated neurological or psychological problems. In essence, goal is to identify cognitive strengths and weaknesses Unlike the use of neuroimaging techniques such as MRI, CT scans and EEG where

the focus is on nervous system structures, neuropsychology seeks to understand how various components of the brain are able to do their jobs (FUNCTIONING) Entails a detailed knowledge of brain anatomy, the role that different brain areas serve and how these functions are likely to be impacted by various disorders AB include point about assessing across biopsychosocial domains PURPOSES OF NEUROPSYCH

TESTING Lesion Location Diagnosis Level of Functioning Strengths Weaknesses Conditions

Rehab Recommendations Prognosis BRIEF HISTORY Largely rooted in the need for screening and diagnosing brain injured and behaviorally disturbed servicemen

during World War I Continued to be driven by rehabilitation needs of veterans after combat Evolution of field equally impacted by movement to measure the concept of intelligence and educational evaluation Led to recognition of statistics-dependent testing,

normative data NORMATIVE-BASED TESTING NEUROPSYCH EVALUATION VS. NEUROIMAGING MRI/CT

Examiner bases clinical opinion on visual representation of brain anatomy/ metabolic processes Neuropsych assess. based on functional status of patient and norm-based, providing more accurate depiction of patients abilities While imaging typically more clearly observable for acute ABI, as brain heals, images change, but deficits remain

Neurologist's expertise is diagnosing and treating the structural and physiological consequences of brain injuries and neurological illnesses. Neuropsychologists assess the effects of brain injuries and illnesses on cognition and behavior; they are experts in assessing functional capacities ELECTROENCEPHALOGRAM (EEG)

COMPUTED TOMOGRAPHY (CT) CT NORMAL VS. ABNORMAL ATROPHY NORMAL CT

SEVERE BIFRONTOTEMPORAL ATROPHY CT (SMALL VESSEL ISCHEMIA) MAGNETIC RESONANCE IMAGING (MRI)

DIFFUSION TENSOR IMAGING (DTI) POSITRON EMISSION TOMOGRAPHY (PET)

NEUROPSYCH VS. NEUROIMAGING CASE EXAMPLE 1 Paula, 77 Family reported sig. STM problems, confusion when completing tasks, irritability, geographic confusion, and sig. problems completing functional activities MRI reflected age-appropriate cortical atrophy

Neuropsych results suggested statistically sig. verbal and visual STM, executive, and visuospatial deficits Pt was diagnosed with an Alzheimers Dementia NEUROPSYCH VS. NEUROIMAGING CASE EXAMPLE 2 Ruth, 81

Family reported sig. STM impairment and functional problems CT scan reflected minimal small vessel ischemic changes Neuropsych testing revealed moderate to severe verbal and visual STM deficits Pt diagnosed with a Vascular Dementia

VALUE OF NEUROPSYCHOLOGICAL TESTING Specific profiles obtained on testing reveal more detailed data on location and severity of injury Injury can cause inflammatory response affecting whole brain

Pressure-related affects on other areas Coup-Contrecoup Frontal- everything connection (i.e., frontal-cerebellar) Helps differentiate co-morbid conditions TYPES OF NEUROPSYCHOLOGICAL ASSESSMENTS Low-level evaluation

Glasgow Coma Scale Brief Cognitive Examinations Montreal Cognitive Assessment (MOCA) Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Neurobehavioral Cognitive Status Examination

(Cognistat) COMPREHENSIVE NEUROPSYCHOLOGICAL BATTERY Extensive battery involving assessment of multiple cognitive and biopsychosocial domains Cognitive domains

Verbal/language abilities Visuospatial skills Executive functioning Attention, planning/sequencing, working memory, mental flexibility Verbal and Visual Memory

Processing Speed Motor/sensory NEUROPSYCH SUBTEST EXAMPLES REY-O COMPLEX FIGURE COPY

ALZHEIMERS PATIENT COPY TRAILMAKING B SUBTEST STROOP SUBTEST

PICTURE NAMING SUBTEST LIST LEARNING SUBTEST PROCESSING SPEED MEASURE

COMPREHENSIVE NEUROPSYCHOLOGICAL BATTERY Emotional Factors Depression Anxiety Adjustment to medical condition Lability

PTSD MEDICAL HISTORY REVIEW Medical Co-morbidities i.e. cardiovascular disease, diabetes Medications

Substance Abuse Neuroimaging findings SOCIAL/ENVIRONMENTAL FACTORS Family/Social Relationships Financial Status Academic History

Vocational History Living Situation STROKE CASE EXAMPLE 1 Include walk-through of interview, chart review, battery, and interpretation

QUESTIONS? REFERENCES Neuropsychological Assessment, Fifth Edition; Lezak, Howieson, Bigler, & Tranel Advanced Psychological Assessment, P.C. ( www.advancedpsy.com)

Signs of cerebral small vessel disease. From Inzitari et al, BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477 Inflammatory Response in Acute Traumatic Brain Injury. Current Opinion in Critical Care: Apr 2002

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